MEDICARE: MELISSA BEALLY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VG0400X	Gynecology Physician	036143475	IL
2	390200000X	Student in an Organized Health Care Education/Training Program		LA
3	207V00000X	Obstetrics & Gynecology Physician	MD-56370	IA

General Provider Information

NPI Number	:	1306281480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA BEALLY MD

Provider Business Mailing Address
First Line	:	1430 TULANE AVE
Second Line	:	SL-11
City	:	NEW ORLEANS
State	:	LA
Zip	:	70112-2632
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 ERIE CT STE 6040
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60302-2510
Country	:	US
Telephone Number	:	708-386-1301
Fax Number	:	708-386-3053

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2013
Last Update Date	:	01/19/2026

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Directions to “ MELISSA BEALLY MD” Practice Location

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